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Do I need ankle reconstruction?

My right ankle hurts pretty bad for a few days after I run at all, even if I wear a brace.  I also have to wear a brace daily just for work. If I don't, it kills me over the next few days. 

The ankle feels a bit "weird" all the time but it NEVER rolls on me.  This has been going on for 2 years.  PT makes it worse.  

I've only had 1 or 2 sprains in my life and both were from external factors, ie tripping on a curb jogging at night. In other words, it feels stable to me, I never worry about it "giving way" or anything.  It's just the pain is driving me nuts and preventing my activities.

MRI shows an old ATFL tear and fibular avulsion fracture with a 1.4x.6cm fragment. No cartilage defects or other abnormalities.

Would a Brostrom ankle reconstruction be overkill for this, given no clear instability?

Thank you so much for reading :)  Any thoughts appreciated.

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Dr. Ken J T
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Doctor
12 Streak Score Doctors are able to put a streak together by performing an activity everyday
Hi Lunarorbit,

Thanks for your detailed description! Whether an ankle ligament reconstruction (Brostrom) would benefit you or not, boils down to the assessment of whether your symptoms are due to ankle ligament laxity. 

A lot of times, we expect a torn ligament to manifest as a “loose” ankle that rolls over or gives way easily. 

However, that’s not always true and there are many people who instead have symptoms of an achy and sore ankle with activity instead. This is because the ankle joint mechanics is off due to the loss of ligament function. 

If you’ve had an MRI done already which shows the ankle is healthy except for the ligament tear and bone  avulsion, then there’s a pretty good chance your symptoms are due to the laxity and altered mechanics from the incompetent ligament. Another soft sign is if your ankle feels better or more secure when you wear a brace - this can also be an indicator that the symptoms are due to loss of ligament function. 
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@lunarorbit
Fantastic answer, thanks!